Document 4QrjG8DXn0oyB6Gk8R2mjG8KQ

Form if-ll-lOM-li-H ` STATE Of OHIO Bureau of Workmen's Compensation Duplicate-Record of Proceedings n Employe_____ _______________________________ ________________ ______Claim Noi'll'..107910. Street and No.-il^iQSL.'lklZ'JLP-.llYS:.?-----------------------------------------Date of InjuryJune..Ill ,1-95-7- cityi?oodlau'iJ.J3ij3cinnafci_l__OhioManual No.4233 (State) Employer____PilllipjSarny..Risk No. 1634. Street and No. .1______________________________________________ cityLo_clcland.JL5JlJilfl* (Slate) EXHIBIT 6 Present for Claimant. FINDINGS OF FACTS AND MINUTES (Address) a V Present for Employer-.. (Address) On this day the above numbered claim, together with the proof on file, was presented to the Bureau, considered and a i rinding was made as follows: 1. 1lI i That this claim bo disallowed, for the reason the Administrator finds the filiny of the claim application on December 6,1953 was not made within the statutory tine of one year after the bepinnin," of disability of Juno 1J,1957> nor within u period of six months after the diagnosis of asbostosis on January 5,1955} and there is no jurisdiction to consider tills claim. f IlEI-i:AmKC WlLZSU.-xtiL #1-INSTRUCTIONS TO DELIVERING EMPLOYEE Deliver ONLY to addressee j--j Slio-w address where I--I delivered (Additional charges required for these services) Z RETURN RECEIPT : ~ Received the numbered article described on other side. Date January..13.^1959 Administrator t. ' - ' tV / .. 'O . <-, J 9yv*c.aj.st,..v-i.'I,. I.-.. j, "..uy. vyc._ Deputy Claims Administrator